Role of chest computed tomography in head and neck cancer.
OBJECTIVE
To evaluate the role of chest computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to determine the optimal timing and predictive factors for positive findings.


METHODS
Retrospective analysis.


METHODS
Tertiary referral center.


METHODS
Two hundred seventy screening chest CT scans performed in 192 patients with HNSCC during a 42-month period were reviewed.


METHODS
The scans were categorized as new cases, follow-up cases, or recurrent cases. The results were classified as abnormal or normal. Scans of patients having a radiologic diagnosis of a malignant neoplasm of the lung or an indeterminate lesion were considered abnormal. Factors correlating with an abnormal chest CT scan or development of malignant neoplasm of the lung were analyzed, including the timing of imaging and the patients' clinicopathologic data.


RESULTS
Seventy-nine scans (29.3%) were considered abnormal. The rate of an abnormal scan was significantly higher in the follow-up case group (44.2%) than in the new case group (14.2%) (P < .001). Ten of 15 indeterminate scans (66.7%) with small (<1 cm) solitary pulmonary nodules showed disease progression on subsequent follow-up scans, changing the patients' diagnoses to a malignant neoplasm of the lung. The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site.


CONCLUSIONS
Chest CT is recommended for high-risk patients, especially during the follow-up period. Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms.
Hsu
Yen-Bin
YB
Department of Otolaryngology, Taipei Veterans General Hospital, 201 Shih-Pai Rd, Section 2, Taipei, Taiwan 11217.
Chu
Pen-Yuan
PY
Liu
Juhn-Cherng
JC
Lan
Ming-Chin
MC
Chang
Shyue-Yih
SY
Tsai
Tung-Lung
TL
Huang
Jui-Lin
JL
Wang
Yi-Feng
YF
Tai
Shyh-Kuan
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed / Q000379:methods*